A previously healthy 30 y.o. female noticed left perianal discomfort 36 hrs post anal intercourse (and 12 hours post digital anal insertion). Has frequent, uneventful anal sex, with and without lubrication. Denies ever having vaginal or anal discharge, bleeding or pain. Boyfriend only sexual partner last two years. Symptoms -ve for tenesmus, hematochezia, fever, chills or h/o similar symptoms, recent illness or hemorrhoids. No h/o STD, diverticulosis, IBD or IBS. Pain and tenderness has worsened slightly over 3 days. Worse after long periods sitting, and upon waking each morning. Limited to left perianal area. Describes as "discomfort", though has occasional sharp pains with change in body position. Only mildly increased pain during defecation; no urgency, constipation or diarrhea. No pruritis. Vague as to pain constancy, or if awakened from sleep. Today, noticed toilet paper pink after dabbing anal area (no bowel movement), and had mild dysuria. Denies hematuri or discharge.
Other PMH negative.
O/E Afebrile. Well-looking.
No inguinal lymphadeopathy. Pubic area unshaven.
Linear 1 cm tendon-like swelling extending radially at 4 oclock position. Quite firm. Non fluctuant. Some overlying tenderness and mild erythema. No obvious fissures, tags, hemorrhoids or folliculitis.
Refused rectal exam.
24 hr. repeat exam unchanged.
DDx- perianal abscess/ anal fissure
external hemorrhoid (thrombosed?)
IDEAS, COMMENTS ETC. APPRECIATED.